Skip to main content
Log in

MRI of brachial plexus using diffusion tensor imaging: a pilot study for the use of resolve sequence surgical and radiologic anatomy

  • Original Article
  • Published:
Surgical and Radiologic Anatomy Aims and scope Submit manuscript



Clinical exam is the goldstandard for surgical indication. ENMG and conventional MRI are insufficient to understand the highly variable clinical presentation of brachial plexus (BP) lesions. DTI is based on motion of water molecules and can explore nerve function.


This pilot study of healthy subjects aimed to develop RESOLVE sequence for BP exploration using diffusion MRI. The main objective was to provide complete precise information from DTI cartography associated with anatomical data.


Six healthy volunteers were scanned using 3T PRISMA scanner with anatomic 3D STIR SPACE and RESOLVE diffusion sequences. Diffusion parametric maps of fractional anisotropy (FA) were extracted from RESOLVE acquisitions. A reproducible method for roots volumes and angles measurements was created using 3DSlicer. ROI were segmented on Mean B0 sequences. FA measurements were obtained with ROI on Mean B0 sequences.


RESOLVE sequence was adapted to the BP. Mean FA was 0.30. Angles measurements on 3D STIR SPACE sequences showed increasing values from proximal to distal roots with an 0.6 ICC. Volume measurements on anatomic sequences varied widely from one root to another but did not show any significant difference on laterality.


A new and reproducible method for BP exploration was developed, using MRI RESOLVE DTI sequences. Complete mapping was obtained but a low resolution of track density imaging did not allow to exploit distal nerves. Deterministic tractography principal limit was the lack of resolution. Extraction of diffusion, volumetric and angular parameters of the plexus roots, and scripts creation for image processing was adapted to the healthy BP.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9

Similar content being viewed by others

Data availability

The data presented in this article are protected and encrypted within the Brain and Marrow Institute. None of the datasets are allowed to leave this storage without specific authorization.


  1. Andica C, Hagiwara A, Hori M, Kamagata K, Koshino S, Maekawa T, Suzuki M, Fujiwara H, Ikeno M, Shimizu T, Suzuki H, Sugano H, Arai H, Aoki S (2019) Review of synthetic MRI in pediatric brains: basic principle of MR quantification, its features, clinical applications, and limitations. J Neuroradiol 46:268–275.

    Article  PubMed  Google Scholar 

  2. Chen F, Chen L, Li W, Li L, Xu X, Li W, Le W, Xie W, He H, Li P (2016) Pre-operative declining proportion of fractional anisotropy of trigeminal nerve is correlated with the outcome of micro-vascular decompression surgery. BMC Neurol 16:106.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Chen W-C, Tsai Y-H, Weng H-H, Wang S-C, Liu H-L, Peng S-L, Chen C-F (2014) Value of enhancement technique in 3D–T2-STIR images of the brachial plexus. J Comput Assist Tomogr 38:335–339.

    Article  PubMed  Google Scholar 

  4. Dhollander T, Raffelt D, Connelly A (2016) Unsupervised 3-tissue response function estimation from single-shell or multi-shell diffusion MR data without a co-registered T1 image. Paper presented at the ISMRM Workshop on Breaking the Barriers of Diffusion MRI, Lisbon, Portugal

  5. Durandeau A, Fabre T (2007) Chirurgie de réparation du plexus brachial de l’adulte. EMC-Tech Chir-Orthopédie-Traumatol 2:1–12.

    Article  Google Scholar 

  6. Gasparotti R, Lodoli G, Meoded A, Carletti F, Garozzo D, Ferraresi S (2013) Feasibility of diffusion tensor tractography of brachial plexus injuries at 1.5 T. Invest Radiol 48:104–112.

    Article  PubMed  Google Scholar 

  7. Ho MJ, Ciritsis A, Manoliu A, Stieltjes B, Marcon M, Andreisek G, Kuhn FP (2019) Diffusion tensor imaging of the brachial plexus: a comparison between readout-segmented and conventional single-shot echo-planar imaging. Magn Reson Med Sci 18:150–157.

    Article  PubMed  Google Scholar 

  8. Holdsworth SJ, Skare S, Newbould RD, Guzmann R, Blevins NH, Bammer R (2008) Readout-segmented EPI for rapid high resolution diffusion imaging at 3T. Eur J Radiol 65:36–46.

    Article  PubMed  Google Scholar 

  9. Holdsworth SJ, Yeom K, Skare S, Gentles AJ, Barnes PD, Bammer R (2011) Clinical application of readout-segmented—echo-planar imaging for diffusion-weighted imaging in pediatric brain. Am J Neuroradiol 32:1274–1279.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Jambawalikar S, Baum J, Button T, Li H, Geronimo V, Gould ES (2010) Diffusion tensor imaging of peripheral nerves. Skeletal Radiol 39:1073–1079.

    Article  PubMed  Google Scholar 

  11. Koyasu S, Iima M, Umeoka S, Morisawa N, Porter DA, Ito J, Le Bihan D, Togashi K (2014) The clinical utility of reduced-distortion readout-segmented echo-planar imaging in the head and neck region: initial experience. Eur Radiol 24:3088–3096.

    Article  PubMed  Google Scholar 

  12. Lehmann HC, Zhang J, Mori S, Sheikh KA (2010) Diffusion tensor imaging to assess axonal regeneration in peripheral nerves. Exp Neurol 223:238–244.

    Article  PubMed  Google Scholar 

  13. Marcus JR, Clarke HM (2003) Management of obstetrical brachial plexus palsy Evaluation, prognosis, and primary surgical treatment. Clin plastic surg 30:289–306

    Article  Google Scholar 

  14. Metaizeau JP, Gayet C, Plenat F (1979) Brachial plexus birth injuries. an experimental study (author’s transl). Chir Pediatr 20:159–163

    CAS  PubMed  Google Scholar 

  15. Mittmann A, Comunello E, von Wangenheim A (2008) Diffusion tensor fiber tracking on graphics processing units. Comput Med Imaging Graph 32:521–530.

    Article  PubMed  Google Scholar 

  16. Moayeri N, Bigeleisen PE, Groen GJ (2008) Quantitative Architecture of the brachial plexus and surrounding compartments, and their possible significance for plexus blocks. Anesthesiology 108:299–304.

    Article  PubMed  Google Scholar 

  17. Oudeman J, Coolen BF, Mazzoli V, Maas M, Verhamme C, Brink WM, Webb AG, Strijkers GJ, Nederveen AJ (2016) Diffusion-prepared neurography of the brachial plexus with a large field-of-view at 3T: diffusion-prepared neurography with large FOV. J Magn Reson Imaging 43:644–654.

    Article  PubMed  Google Scholar 

  18. Porter D, Mueller E (2003) Multi-shot diffusion-weighted EPI with readout mosaic segmentation and 2D navigator correction. In: Proceedings of the 11th Annual Meeting of ISMRM, Toronto, Canada

  19. Tagliafico A, Calabrese M, Puntoni M, Pace D, Baio G, Neumaier CE, Martinoli C (2011) Brachial plexus MR imaging: accuracy and reproducibility of DTI-derived measurements and fibre tractography at 3.0-T. Eur Radiol 21:1764–1771.

    Article  PubMed  Google Scholar 

  20. Tanitame K, Iwakado Y, Akiyama Y, Ueno H, Ochi K, Otani K, Takasu M, Date S, Awai K (2012) Effect of age on the fractional anisotropy (FA) value of peripheral nerves and clinical significance of the age-corrected FA value for evaluating polyneuropathies. Neuroradiology 54:815–821.

    Article  PubMed  Google Scholar 

  21. Tournier J-D, Smith R, Raffelt D, Tabbara R, Dhollander T, Pietsch M, Christiaens D, Jeurissen B, Yeh C-H, Connelly A (2019) MRtrix3: a fast, flexible and open software framework for medical image processing and visualisation. Neuroimage 202:116137.

    Article  PubMed  Google Scholar 

  22. Vargas M-I, Beaulieu J, Magistris M-R, Della Santa D, Delavelle J (2007) Aspects cliniques, électroneuromyographiques et IRM des traumatismes du plexus brachial. J Neuroradiol 34:236–242.

    Article  PubMed  Google Scholar 

  23. Vargas MI, Viallon M, Nguyen D, Beaulieu JY, Delavelle J, Becker M (2010) New approaches in imaging of the brachial plexus. Eur J Radiol 74:403–410.

    Article  CAS  PubMed  Google Scholar 

  24. Vargas MI, Viallon M, Nguyen D, Delavelle J, Becker M (2010) Diffusion tensor imaging (DTI) and tractography of the brachial plexus: feasibility and initial experience in neoplastic conditions. Neuroradiology 52:237–245.

    Article  PubMed  Google Scholar 

  25. Wada K, Hashimoto T, Miyagi R, Sakai T, Sairyo K (2017) Diffusion tensor imaging and tractography of the sciatic nerve: assessment of fractional anisotropy and apparent diffusion coefficient values relative to the piriformis muscle, a preliminary study. Skeletal Radiol 46:309–314.

    Article  PubMed  Google Scholar 

  26. Wade RG, Bligh ER, Nar K, Stone RS, Roberts DJ, Teh I, Bourke G (2020) The geometry of the roots of the brachial plexus. J Anat 237:999–1005.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Wade RG, Tanner SF, Teh I, Ridgway JP, Shelley D, Chaka B, Rankine JJ, Andersson G, Wiberg M, Bourke G (2020) Diffusion tensor imaging for diagnosing root avulsions in traumatic adult brachial plexus injuries: a proof-of-concept study. Front Surg 7:19.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Yoshimura Y, Kuroda M, Sugianto I, Bamgbose BO, Miyahara K, Ohmura Y, Kurozumi A, Matsushita T, Ohno S, Kanazawa S, Asaumi J (2018) The usefulness of readout-segmented echo-planar imaging (RESOLVE) for bio-phantom Imaging using 3-tesla clinical MRI. Acta Med Okayama 72:7

    Google Scholar 

  29. Yushkevich PA, Piven J, Hazlett HC, Smith RG, Ho S, Gee JC, Gerig G (2006) User-guided 3D active contour segmentation of anatomical structures: significantly improved efficiency and reliability. Neuroimage 31:1116–1128.

    Article  PubMed  Google Scholar 

Download references


The authors would like to thank the CENIR team for the year of work by their side at the ICM. The authors would like to thank the Trousseau team for the opportunity, the surgeries and the research coming from this partnership. The authors are grateful to Nikki Sabourin-Gibbs, CHU Rouen, for her help in editing the manuscript.


No funding was provided for this research.

Author information

Authors and Affiliations



MP: Protocol and project development, Manuscript writing, Data collection. MD: Data management, protocol development, Data analysis. RV: Project development, Correction. SL: Protocol and project development, Correction. FF: Correction. MB: Project development, Correction.

Corresponding author

Correspondence to M. Payen.

Ethics declarations

Conflict of interest

Conflict of Interest concerning the research related to the manuscript: None. Grant support: This research was supported by a grant from The MAMUTH Hospital-University Federation for Innovative Therapies in Musculoskeletal Diseases. Mathilde Payen: None. Mélanie Didier: None. Raphael Vialle: Received consulting fees from NuVasive, EOS imaging, Spineguard and Stryker Spine, independently from this study. Franck Fitoussi: None. Stéphane Lehericy: None. Manon Bachy: None.

Ethical approval

This category 2 research has obtained the CPP (national number: 2021-A02871-40). Each participant gave written consent prior to any MRI acquisition.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Payen, M., Didier, M., Vialle, R. et al. MRI of brachial plexus using diffusion tensor imaging: a pilot study for the use of resolve sequence surgical and radiologic anatomy. Surg Radiol Anat 45, 1567–1577 (2023).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: